Emergency Contraceptive Pills: The Word from Medical Professionals* Print

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Experts estimate that, in the United States, up to 95 percent of teenage pregnancies are unintended.1 At the same time, at least 40 percent of all pregnancies in the United States are unintended.1

Unintended pregnancy can occur when a woman’s regular method of contraception fails or she uses it incorrectly. For example, she might forget to take her birth control pills for two or three days in a row. She might be unable to get her contraceptive injection on time. Her diaphragm might slip. Or she and her partner might accidentally tear a condom. Unintended pregnancy can also occur after a couple has had unprotected sex.

Finally, unintended pregnancy can occur as a result of rape or sexual assault. In fact, experts estimate that at least 25,000 pregnancies occur each year in the United States as a result of forced sex.2

Yet, many Americans –females and males, health professionals and consumers – do not know that there is a contraceptive method that works after unprotected sexual intercourse to prevent pregnancy.3,4,5 This method is known as emergency contraception. Emergency contraception (EC) is also known as the ‘morning after pill’ and Plan B®.

EC is up to 89 percent effective in preventing pregnancy, depending on how quickly a woman begins the pills, the type of pills taken, and when the sex occurred during the woman’s menstrual cycle.6 In August 2006, the Food and Drug Administration (FDA) ruled that women (and men) ages 18 and older can obtain Plan B® without a prescription.7 Plan B® is the only prepackaged, dedicated emergency contraceptive pill product currently available in the United States. On March 23, 2009, the U.S. District Court for the Eastern District of New York ruled that the Food and Drug Administration (FDA) must extend over-the-counter access to Plan B to 17 year olds by the end of April 2009 and must reconsider making it available without a prescription for those younger.24 Young women under age 18 still need a prescription to receive Plan B®.

Please note (July 2009): The newly approved Plan B One-Step is now available without a prescription for women and men 17 and older.

As a health care provider, you can take a number of steps to ensure that patients know about this important pregnancy prevention method. Prescribe or recommend emergency contraceptive pills for patients who are at risk of unintended or unwanted pregnancy – regardless of whether the risk is due to coercion, improper use of a regular contraceptive method, method failure, or nonuse of any regular contraception. The American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Adolescent Medicine, and other reputable medical organizations recommend: 1) giving young women emergency contraception (or a prescription) in advance of need so that they will have EC on hand in an emergency; 2) prescribing/recommending EC without concern regarding repeated use; and 3) responding immediately – without exams or tests of any kind – to a young woman’s need for emergency contraceptive pills.6,8,9 Finally, ensuring that services are welcoming, affordable, and confidential can encourage young women to seek the reproductive health care they need to prevent unintended or unwanted pregnancy as well as sexually transmitted infections (STIs), including HIV.6,8,9,10,11


Emergency contraceptive pills are hormonal contraception. Specifically, they are the same type of hormonal contraception that comprises regular contraceptive pills. Emergency contraceptive regimens include levonorgestrel-only (progestin-only) and the Yuzpe regimen of combined estrogen and progestin.

  • The levonorgestrel-only regimen consists of either: a) 1.50 mg of levonorgestrel in a single dose; or b) two doses of 0.75 mg each, taken up to 12 hours apart.
  • The combined estrogen-progestin regimen consists of two doses, taken 12 hours apart, of 100 mcg ethinyl estradiol plus 0.50 mg of levonorgestrel.
The latest research shows that levonorgestrel, taken in a 1.50 mg single dose, is the most effective regimen and has the fewest side effects.6,12

Emergency contraceptive pills are currently available in the United States either in a specifically packaged levonorgestrel product (Plan B®) or in the use of various brands of combined pills (see chart below, current as of April 2009. See a list of contraceptive brands that can be used as emergency contraception and the number of pills to prescribe, current as of April 2009. For a list that is updated whenever there is new information, please visit


In 1997, the U.S. Food and Drug Administration (FDA) recognized the use of oral contraceptives as being safe and effective as emergency contraception.15 Emergency contraceptive pills are effective in preventing pregnancy after unprotected sex. They are especially effective when begun within 12 to 24 hours after sex. The pills remain effective when begun up to 72 hours after sex. Some studies indicate that they continue to be effective, although somewhat less so, when begun up to 120 hours after sex.6,12 Studies indicate that efficacy declines substantially over time.6,12,14

The levonorgestrel-only regimen is more effective than the combined estrogen-progestin regimen.

  • Four studies of the levonorgestrel regimen in almost 5,000 women showed that it reduced a woman’s chance of pregnancy by up to 93 percent (range 60 to 93 percent).12,16,17,18,19
  • A meta-analysis of eight studies of the combined estrogen-progestin regimen in over 3,800 women concluded that this regimen prevented about 74 percent of pregnancies (range 56 to 89 percent).20
  • Finally, a randomized trial compared the two regimens and found that the chance of pregnancy among women who received the levonorgestrel-only regimen was about one-third (0.36) the chance among those who received the combined regimen.12,17


Emergency contraceptive pills work in two established ways to prevent pregnancy. Emergency contraceptive pills have been proven to delay ovulation. It is probable that they inhibit fertilization. It is also possible, though unproven, that emergency contraceptive pills may prevent implantation. The medical community widely agrees that pregnancy begins when implantation is complete.6,12

Emergency contraceptive pills are sometimes confused with medical abortion. Whereas mifepristone (RU-486) terminates an existing pregnancy, emergency contraception is effective only before the pregnancy is established (that is, before implantation). If a woman is already pregnant, emergency contraception will not cause an abortion.6 By contrast, mifepristone is an entirely different medication, unrelated to hormonal contraception.


Emergency contraceptive pills are entirely safe. In fact, the American College of Obstetricians and Gynecologists, American Academy of Pediatrics, Society for Adolescent Medicine, World Health Organization, and many other reputable medical organizations assert that emergency contraceptive pills are entirely safe even for women for whom regular contraceptive pills are unsafe as well as those for whom pregnancy is a serious risk.6,8,9,21 (See World Health Organization findings under Statements of Prominent Medical Organizations, below.)

Emergency contraceptive pills do not cause birth defects. Over 40 years experience with oral contraceptives has shown no risk of birth defects if a woman is already pregnant when she takes them. Emergency contraceptive pills are contraindicated for pregnant women only because the medication will not end a pregnancy.6,8,9,12,21 Studies of older, higher-dose oral contraceptives have shown that emergency contraception confers no increased risk to an established pregnancy or harm to a developing embryo.6


Because emergency contraceptive pills are not dangerous under any known circumstances, routine screening – such as pelvic exam or pregnancy and/or blood test – is entirely unnecessary. If a woman has missed her period, she might also request a pregnancy test. However, administration of emergency contraceptive pills should not be delayed in order to perform any test.6,8,9,12

Side Effects

Short-term side effects can include nausea, vomiting, abdominal pain, fatigue, headache, dizziness, breast tenderness, and irregular vaginal spotting or bleeding. The levonorgestrel-only regimen carries significantly lower chance than the combined regimen of causing nausea and vomiting.6,12

To minimize nausea and vomiting, American College of Obstetricians and Gynecologists, Society for Adolescent Medicine, and International Consortium for Emergency Contraception recommend the levonorgestrel-only regimen in preference to the combined estrogen-progestin regimen.6,8,12 In addition, medical experts also recommend that:

  • Women using the combined regimen receive pretreatment with antiemetic drugs (meclizine or metoclopramide).
  • If vomiting occurs within two hours after either dose, repeat the dose.
  • In cases of severe vomiting, consider vaginal administration of the dose.6,12

Women should be advised that their menses will probably occur within a week before or after the time they would have expected it. If menses is delayed more than two weeks beyond the time expected, the woman should seek a pregnancy test and, if she is pregnant, appropriate care.6,12

Making Emergency Contraceptive Pills Readily Available to Young Women

Young women face barriers to reproductive health care. These barriers constitute an additional obstacle to their seeking, receiving, and using emergency contraceptive pills during the relatively short time frame of the pills’ effectiveness. In order to help young women avoid unintended and unwanted pregnancy, you can work to dismantle these barriers in a number of ways.

  1. Train all staff, from nurse practitioners to receptionists, to respond promptly and positively to phone requests for emergency contraception. Train staff to inquire about the interval since the incident of unprotected sex.
    • Make sure that staff understands that the longer the time lapse, the more urgent the need for emergency contraception. The pills remain effective when begun up to 72 hours after unprotected sex. Some studies indicate that they continue to be effective, although somewhat less so, when begun up to 120 hours after sex.6,12Studies indicate that efficacy declines substantially over time.6,12,14
    • At the same time, be sure that staff understands that emergency contraceptive pills are most effective when begun within 12 hours after unprotected sex. So, if the incident just occurred, staff should still ensure that the patient’s need is met promptly.
    • Encourage women ages 18 and older to go immediately to a nearby pharmacy, and bring proof of age, so that they can purchase and take Plan B®. Although the package instructs young women to take the pills 12 hours apart, the Society for Adolescent Medicine recommends that young women be advised to take both pills together, at one time – this is an easier regimen to follow and just as effective.8
  2. If your practice’s protocol requires seeing the patient in order to prescribe medication, then be sure that she receives an immediate appointment (the same day). If she is a regular patient under age 18, and you can phone in a prescription without a prior office visit, please do so.
  3. Determine which pharmacies in your community carry emergency contraceptive pills, especially Plan B®. Identify the pharmacies that will provide the medication promptly and courteously. Refer your patients to these pharmacies. If no such pharmacy exists in your community, consider repackaging levonorgestrel-only oral contraceptives to give patients in an emergency.
  4. Offer a sliding fee scale so that young women (who are more likely than older women to lack health insurance) can afford the emergency contraceptive pills they need.
  5. For young women under age 18 who are seeking a prescription for emergency contraceptive pills, offer free or very low cost services so that they do not have to use their parents’ insurance. Doing this for your younger patients will help ensure their confidentiality and increase the likelihood of their seeking the care they need.
  6. Ensure that the practice’s protocols do not require pregnancy test, pelvic exam, or other laboratory tests as prerequisites for obtaining emergency contraceptive pills.
  7. Be sure that the waiting room and examining rooms provide pamphlets, posters, and wallet cards educating women about emergency contraceptive pills and about the importance of using regular contraception.
  8. During office visits, counsel young people about contraception. Offer advance prescriptions for emergency contraceptive pills to all women under age 18 who may be at risk of pregnancy.
  9. Use the opportunity provided by a young woman’s seeking emergency contraceptive pills to schedule a follow-up appointment so that she can then receive other needed health care, such as contraception, STI testing, and/or pregnancy testing (if indicated).
  10. Regardless of the reason why a young woman needs emergency contraceptive pills, treat her respectfully and non-judgmentally.


Statements of Prominent Medical Organizations regarding Emergency Contraceptive Pills**

  • American College of Obstetricians and Gynecologists: Emergency contraception should be offered to women who have had unprotected or inadequately protected sexual intercourse and who do not desire pregnancy… The levonorgestrel-only regimen is more effective and is associated with less nausea and vomiting and should, if available, be used in preference to the combined estrogen-progestin regimen…. Prescription or provision of emergency contraception in advance of need can increase availability and use… No clinical examination or pregnancy testing is necessary before provision or prescription of emergency contraception… Emergency contraception may be made available to women [who have] contraindications to the regular use of conventional oral contraceptive preparations.6
  • Society for Adolescent Medicine: Adolescent health care providers are encouraged to counsel all adolescents about emergency contraceptive pills during visits for acute as well as routine health care... All female adolescents being treated for sexual assault should be counseled about emergency contraception and offered a complete course of emergency contraceptive treatment at that time… Provision of emergency contraception should not be contingent on an adolescent’s receiving pregnancy testing, pelvic examination, Pap smear, or STI testing… Health care providers should provide progestin-only emergency contraceptive pills as the regimen of choice because of higher efficacy and lower side effects. Adolescents should be counseled to take both pills at once [emphasis added] (rather than the current FDA-approved regimen of the first tablet immediately and the second 12 hours later).8
  • American Academy of Pediatrics: Emergency contraception has the potential to further decrease the rate of unintended teen pregnancies in the United States… Education and counseling about emergency contraception should be part of the annual preventive health care visit for all teen and young adult patients when sexuality issues are addressed… Advance prescription should be considered for teens and young adults… An increase in awareness and availability of emergency contraception does not change reported rates of sexual activity or increase the frequency of unprotected intercourse among adolescents… The AAP continues to support improved availability of emergency contraception to teens and young adults, including over-the-counter access and limiting the barriers to access placed by some health care providers and venues.9
  • American Medical Association: It is the policy of the AMA to enhance efforts to expand access to emergency contraception, including making emergency contraceptive pills more readily available through hospitals, clinics, emergency rooms, acute care centers, and physicians’ offices… Emergency contraception is considered safe and effective by the medical community as a whole… Given that emergency contraceptive pills are more effective the sooner they are used, the Council believes establishing prescription and dispensing mechanisms that are convenient for women is crucial to their ability to use the therapy effectively… Physicians could also work to ensure that office staff answering the telephone and scheduling appointments is aware of [emergency contraceptive pills] and able to arrange immediate care for women who call seeking emergency contraceptive treatment.10
  • American Medical Women’s Association: AMWA agrees with respected organizations such as the National Institutes of Health and the American College of Obstetricians and Gynecologists (ACOG) in defining pregnancy as beginning with implantation…6,22 Emergency contraceptive pills work prior to implantation and therefore are considered by these respected organizations and AMWA as a contraceptive, not as an abortifacient. Emergency contraceptive pills do not affect an established pregnancy and numerous studies of the teratologic risk of conception during regular use of oral contraceptives (including the use of older, higher-dose preparations) found no increase in risk.6 AMWA affirms its commitment to supporting reproductive choice for women and believes that emergency contraception is an important option. AMWA is committed to promoting awareness of and improving access to emergency contraception for women of diverse ethnic and socioeconomic backgrounds.11
  • American Nurses Association: There are safe and effective measures available for emergency contraception… As nurses, [we] individually and collectively, can educate school administrators, parents and other policy makers about the severity of the public health issues of teen pregnancy, STDs, and sexual abuse in the community and in this country… [We] can advocate on behalf of more comprehensive approaches for educating teens in practice settings, community, and schools… [We] can be sure that there are available and affordable and non-punitive resources for teens to obtain contraceptive information and protection in [the] community.23

The position of these respected medical organizations is supported by findings of the World Health Organization and the U.S. Food and Drug Administration:

  • World Health Organization: Medical eligibility criteria include no conditions in which the risks of emergency contraceptive pills outweigh the benefits. Evidence supports emergency contraceptive use in women who: are breastfeeding; have a history of ectopic pregnancy; have been raped; and/or have a history of repeated use of emergency contraceptive pills. In addition, because the use of emergency contraceptive pills is less than the regular use of oral contraceptive pills (and emergency contraceptive pills, thus, have less clinical impact), the World Health Organization’s review of the medical literature found that emergency contraceptive pills are appropriate for use in women with a history of cardiovascular complications, angina pectoris, migraine, and/or severe liver disease.21

As for the U.S. Food and Drug Administration, emergency contraceptive pills meet all the FDA’s requirements for over-the-counter (non-prescription) status: 1) a woman can, and indeed always does, self-diagnose her need for emergency contraception; 2) swallowing pills does not require medical supervision; and 3) emergency contraceptive pills are safe and effective.

In 2004, the FDA’s joint advisory committee on women’s reproductive health voted 23 to four in favor of non-prescription status for Plan B®, the only pre-packaged, dedicated emergency contraceptive pill product currently available in the United States.8 In 2006, the FDA approved nonprescription status for Plan B® for women age 18 and older.7 Pharmacies began making emergency contraception available without a prescription in early 2006. On March 23, 2009, the U.S. District Court for the Eastern District of New York ruled that the Food and Drug Administration (FDA) must extend over-the-counter access to Plan B to 17 year olds by the end of April 2009 and must reconsider making it available without a prescription for those younger.24 Young women under age 18 still need a prescription to receive Plan B®.

* This document reports the assessments by major medical organizations that conducted reviews of the extensive medical literature on emergency contraception.

** Except where noted by brackets [ ], these are exact quotations from the cited documents.

Written by Sue Alford, MLS
Advocates for Youth © 2008
An earlier version of this publication was funded by New Morning Foundation

  1. Abma JC et al. Fertility, Family Planning and Women’s Health: New Data from the 1995 National Survey of Family Growth. [Vital and Health Statistics, Series 23, no. 19] Hyattsville, MD: NCHS, 1997.
  2. Stewart FH, Trussell J. Prevention of pregnancy resulting from rape: a neglected preventive health measure. American Journal of Preventive Medicine 2000; 19:228-229.
  3. Harper CC, Cheong M, Rocca CH, Darney PD, Raine TR. The effect of increased access to emergency contraception among young adolescents. Obstetrics & Gynecology 2005; 106:483-491.
  4. Petitti DB, Harvey SM, Preskill D, Beckman LJ, Postlethwaite D et al. Emergency contraception: preliminary report of a demonstration and evaluation project. Journal of the American Medical Women’s Association 1998; 53(Supplement 2): 251-254.
  5. Philliber Research Associates. Knowledge of Emergency Contraception, September 2006. Research on behalf of New Morning Foundation. Columbia SC: South Carolina Emergency Contraception Initiative, 2006.
  6. American College of Obstetricians and Gynecologists. Emergency contraception. ACOG Practice Bulletin: Clinical Management Guidelines, December 2005 (#69).
  7. Food and Drug Administration.  “Plan B®: Questions and Answers.” ; accessed 02/01/2008.
  8. Society for Adolescent Medicine. Provision of emergency contraception to adolescents: position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 2004; 35:66-70.
  9. American Academy of Pediatrics, Committee on Adolescence. Emergency contraception: policy statement. Pediatrics 2005; 116:1038-1047.
  10. American Medical Association, Council on Medical Service. Access to Emergency Contraception [CMS Report 1 – I-00] Chicago, IL: AMA, 2000.
  11. American Medical Women’s Association. Emergency Contraception; ; last accessed 02/01/2008.
  12. International Consortium for Emergency Contraception. Emergency contraceptive pills: Medical and Service Delivery Guidelines, 2nd edition. New York: Author, 2004; ; last accessed 2/10/2008.
  13. Emergency Contraception Website ( Answers to Frequently Asked Questions about … Types of Emergency Contraception. Princeton NJ: Princeton;; last accessed 02/01/2008.
  14. Conard LAE, Fortenberry JD, Blythe MJ, Orr DP. Emergency contraceptive pills: a review of the recent literature. Current Opinion in Obstetrics and Gynecology 2004; 16:389-395.
  15. Food and Drug Administration. Prescription drug products: certain combined oral contraceptives for use as postcoital emergency contraception. Federal Register 1997; 62:8610-8612.
  16. Von Hertzen H, Piaggio G, Ding J, Chen J, Song S et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial. Lancet 2002; 360:1803-1810.
  17. Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet 1998; 352:428-433.
  18. Arowojolu AO, Okewole IA, Adekunle AO. Comparative evaluation of the effectiveness and safety of two regimens of levonorgestrel for emergency contraception in Nigerians. Contraception 2002; 66:269-273.
  19. Ho PC, Kwan MS. A prospective randomized comparison of levonorgestrel with the Yuzpe regimen in post-coital contraception. Human Reproduction 1993; 8:339-92.
  20. Trussell J, Rodriguez G, Ellertson C. Updated estimates of the effectiveness of the Yuzpe regimen of emergency contraception. Contraception 1999; 59:147-151.
  21. World Health Organization. Medical Eligibility Criteria for Contraceptive Use. Geneva, Switzerland, Author, 2004; ; last accessed 02/01/2008.
  22. U.S. Government Printing Office. OPRR reports: protection of human subjects. Code of Federal Regulations 46, 1983.
  23. Schumann MJ. Prevention of adolescent pregnancy and sexually transmitted disease: a moral imperative, a public health imperative or both? Nursing World: Ethics and Human Rights Issues Updates 2002; 1(3).
  24. Stein, Rob.  “FDA Ordered to Rethink Age Restriction for Plan B.” Washington Post, Tuesday, March 24, 2009.  Accessed from on April 15, 2009.

This publication is a part of the From Research to Practice series.

Emergency Contraceptive Pills: Selected, Annotated Bibliography* Print

Also available in [PDF] format.

The following resources have been carefully selected to lead health care providers, educators, and other youth serving professionals to high quality, reliable information on emergency contraceptive pills. This document includes online links to: medical organizations’ policy statements; Web sites and literature reviews; and consumer health information.

Medical Organizations’ Policy Statements on Emergency Contraceptive Pills

Position statements of prominent medical organizations regarding emergency contraceptive pills, their efficacy, and availability can be viewed at the Web links given below. Where noted, the statement is only available to members.

American Academy of Pediatrics, Committee on Adolescence. Emergency contraception: policy statement. Pediatrics 2005; 116:1026-1035;;116/4/1026

American College of Obstetricians and Gynecologists. Emergency contraception. ACOG Practice Bulletin: Clinic Management Guidelines [No. 69]. Washington, DC: Author, December 2005; members can access this document at

American Medical Association, Council on Medical Service. Access to Emergency Contraception [H-75.985] Chicago, IL: AMA, 2006;

American Medical Women’s Association. Emergency Contraception. Arlington, VA: Author, 2005;

American Pharmacists Association: Emergency Contraception: the Pharmacist’s Role, updated edition [APhA Special Report] Washington, DC: Author, 2004; this continuing education booklet is available online to members at

Association of Reproductive Health Professionals. Position Statement;

Society for Adolescent Medicine. Provision of emergency contraception to adolescents: position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 2004; 35:66-70;

Professional Resources on Emergency Contraceptive Pills

For current information about emergency contraception (EC), visit the following sites.

American Society for Emergency Contraception: ASEC is a collaboration of organizations working to improve women's access to emergency contraception (EC). ASEC is a:

  • Source of information on EC;
  • Watchdog for inaccurate or biased articles in the press;
  • Support to other organizations willing to endorse EC; and
  • Source of a semi-annual electronic newsletter on current EC news and events.

For the newsletter, visit

Association of Reproductive Health Professionals: ARHP has a Web section devoted to EC, including professional and consumer health information, news, fact sheets, and training materials.

National Conference of State Legislatures 50 State Summary of Emergency Contraception Laws Denver CO: Author, 2006; Updated annually, this offers a quick and accurate guide to each state’s laws, if any, on EC.  Operated by the Office of Population Research at Princeton University and by the Association of Reproductive Health Professionals, the site offers accurate information – for professionals and consumers – about emergency contraceptive pills, including:

  • Nationwide (but not comprehensive) directory of medical professionals who will prescribe EC and pharmacies that will fill prescriptions;
  • Current brands of oral contraceptives approved for use as EC; and
  • Summary of current research.

Recent Literature Reviews on Emergency Contraceptive Pills

In addition to the literature reviews included in the position statements of the American Academy of Pediatrics, the American Medical Women’s Association, and the Society for Adolescent Medicine (see links in the first section), other important literature reviews (circa 2004 or later) are listed here.

Conard LAE, Fortenberry JD, Blythe MJ, Orr DP. Emergency contraceptive pills: a review of the recent literature. Current Opinion in Obstetrics & Gynecology 2004; 16:389-395.

International Consortium for Emergency Contraception. Emergency Contraceptive Pills: Medical and Service Delivery Guidelines, 2nd ed. New York: Author, 2004;

Ranney ML, Gee EM, Merchant RC. Nonprescription availability of emergency contraception in the United States: current status, controversies, and impact on emergency medicine practice. Annals of Emergency Medicine 2006; 47:461-471

Trussell J, Stewart F, Raymond EG. Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy. Princeton, NJ: Office of Population Research, Princeton University, February 2008. Available online at

Additional Information for Professionals and Consumers about EC

Food and Drug Administration (FDA):  On August 24, 2006, the FDA ( ) approved nonprescription sales for Plan B® for women 18 years and older. Visit:

Reproductive Health Technologies Project:  Provides information about reproductive health issues, including EC.

Physicians for Reproductive Choice and Health: PRCH offers Resources: Emergency Contraception: A Practitioner’s Guide at

World Health OrganizationMedical Eligibility Criteria for Contraceptive Use, 3rd edition, 2004;

Consumer Health Information Regarding EC

Emergency Contraception Web Site:   The site provides accurate information and a directory of local clinicians willing to provide EC.

Advocates for Youth: This site offers reliable and accurate information about EC – for professionals, youth, and parents. It also offers access to Advocates’ unique library of research on adolescent reproductive and sexual health.

Back Up Your Birth Control: The Campaign encourages women to get emergency contraceptive pills from their health care provider before they need them.

Go Ask Alice: Produced by Columbia University's Health Education Program, this site has questions and answers on all kinds of relationship, sexuality, and sexual health issues.

Planned Parenthood Federation of America: This page offers information on EC, its history, barriers to access, and the difference between emergency contraception and abortion as well as referral to local clinics.

Sex Etc: By teens and for teens, this site helps youth stay healthy, including avoiding unintended pregnancy.

Planned Parenthood Teens: This site offers reliable and accurate information on sexuality and relationships as well as referral to local Planned Parenthood clinics.

* For a comprehensive bibliography of medical and public health research related to emergency contraceptive pills, please visit:

Compiled by Sue Alford, MLS for Advocates for Youth © 2009
An earlier version of this publication was funded by New Morning Foundation

This publication is a part of the From Research to Practice series. 

Youth Reproductive and Sexual Health in Botswana Print

Also available in [PDF] format.

Young people ages 10 to 24 comprise 700,000, or 38.9 percent, of the 1.8 million people living in Botswana.1 This group of young people is the largest group ever to be entering adulthood in Botswana’s history. But largely because of the devastation caused by HIV and AIDS, Botswana's population is currently declining -  it is projected that in 2025, there will be six-hundred thousand young people ages 10 to 24 in the country.1 Young people in Botswana, especially young women, face many challenges to their sexual and reproductive health, including high rates of maternal mortality, increased risk of violence and HIV due to widespread alcohol abuse, and the second highest HIV prevalence of any nation. Youth-inclusive, science-based programs can provide young people with sexual health information, life skills, and services to meet their sexual and reproductive health needs.

Some Health Indicators are Encouraging, but Young People Remain at Risk for Negative Sexual Health Outcomes

  • Among unmarried adolescents, the average age of sexual initiation is 17.5 years.2 
  • In one study, among young people ages 15-24, 88 percent of men and 75 percent of women used a condom at their last high-risk sexual activity (sex with a non-regular partner).3  
  • While information on contraceptive use among young people in general is not available, less than half of married women (44 percent) ages 15-49, use contraception.1 
  • Over a quarter of young women ages 15-19 have begun having children.4   Among 12-14 year old females in 2001, 12 percent had been pregnant, and 47.3 percent of 15-24 year olds had been pregnant.5  
  • In Botswana, the maternal death rate is high at 326 per 100,000 live births.   Risk is higher among teenaged mothers because they are more likely to experience an unsafe abortion and because they experience a higher risk of complications at birth due to underdeveloped bodies.5
  • Among young people ages 15-24, the prevalence of HIV/AIDS is on the decline, but still very high with 15.3 percent of young women and 5.1 percent of young men living with HIV in 2007 as opposed to 30-45 percent and 12.9-19.3 percent living with HIV, respectively, in 2001.7,16 
  • There is no formal sex education in schools in Botswana, and studies show that many parents are uncomfortable talking about sexuality with their children.  However, young people receive some information about sexuality and HIV prevention both informally from friends and acquaintances, and through Botswana's HIV prevention social marketing programs.2

Young People, Especially Young Women, are at Serious Risk of HIV Infection

  • The national HIV prevalence of adults between the ages of 15-49 is 24.9 percent, ranked second highest in the world.7
  • AIDS is the leading cause of death in Botswana and has drastically affected its citizens. Within 15 years, from 1990-2005, life expectancy in Botswana dropped drastically from 65 years to 34 years.1 
  • One study indicates that among youth ages 15-24, as many as 76 percent of young men and 81 percent of young women knew that a healthy-looking person could be infected with HIV.8 But only 33 percent of young men and 40 percent of young women could both identify 2 methods of preventing the transmission of HIV, and reject 3 misconceptions about HIV transmission - indicating that a significant number of young people do not have complete information about HIV.3
  • UNAIDS reports that HIV prevalence among young women ages 15-24 (15.3 percent) is triple that among young men (5.1 percent)..7
  • A total of 57 percent of HIV-infected adults in Botswana are women.3
  • This disproportionate increased risk for HIV transcends the existence of positive trends in education and literacy. For example, women in Botswana have higher literacy rates and higher secondary school enrollment rates than their male counterparts.9 There are, however, still economic disparities between men and women. Forty six percent of females compared to 65 percent of males were found to be economically active.1

Alcohol Abuse Contributes to HIV Risk and Violence

  • In Botswana, alcohol abuse remains the most common form of primary substance abuse, and is strongly associated with HIV risk.10   
  • In a study of adults ages 15-49, from 5 districts in Botswana, 31 percent of men and 17 percent of women met the criteria for heavy alcohol consumption. Heavy alcohol use was associated among men with higher HIV risk behaviors, including  being three to four times as likely to have unprotected sex or multiple partners or to pay for sex. Among women heavy alcohol use was associated with higher rates of unprotected sex and multiple partners, and heavy alcohol users were eight times as likely to sell sex as nondrinkers.10
  • Alcohol abuse combined with existing gender imbalances lead to marital rape and abusive relationships, putting women at risk not just of physical, sexual, and emotional distress but at increased risk of contracting HIV (since condoms are rarely used during sexual assaults).11 

Programs Seek to Help Young People Lead Healthy Lives

  • The Basha Lesdi ("Youth are the Light") project, funded by the US Centers for Disease Control and Prevention (CDC), focuses on youth ages 10 to 17 in Botswana. The project hopes to reach young people with HIV/AIDS prevention information and skills before they engage in risky behaviors, while also developing support from community stakeholders including faith-based groups.12
  • The Social Marketing or Adolescent Health (SMASH) Project, funded by USAID, engaged young people on sexual health issues by facilitating dialogues on reproductive and sexual health through a radio call-in show, youth clubs in schools, peer education, and youth-friendly clinics. The project reports a positive impact resulting from young people’s participation in its design and implementation.13  
  • The African Youth Alliance (AYA) worked in Botswana with youth to plan programs to improve adolescent knowledge, attitudes, values and behavior on matters related to sexual and reproductive health issues, including STIs, HIV/AIDS, smoking, alcohol and substance abuse, as well as to increase the use of sexual and reproductive health information and services.14 
  • Advocates for Youth's YouthLIFE Initiative (Youth Leaders Fighting the Epidemic), was implemented in Botswana, South Africa and Nigeria with a focus on building the capacity of youth-led organizations to better implement HIV prevention programs for youth. In Botswana, Advocates worked with the Youth Health Organization (YOHO) to implement youth-specific HIV/AIDS “edutainment” interventions and to secure greater participation by youth in policy-making bodies.15   

Written by Mimi (Meheret) Melles
Advocates for Youth © April 2009


  1. Population Reference Bureau. “Botswana.” Accessed from on March 27, 2009.
  2. Francoeur, RT and Noonan, RJ. “Botswana.”  International Encyclopedia of Sexuality. Kinsey Institute, 2004. Accessed from on March 27, 2009.
  3. UNAIDS. “Epidemiological Fact Sheets on HIV/AIDS and Sexually Transmitted Diseases: Botswana.” United Nations, 2006.
  4. United Nations Population Fund.  “Overview:  Botswana.” UNFPA, 2005.  Accessed from on March 14, 2008.
  5. United Nations and the Republic of Botswana.  “Goal 5: Maternal Health.” Botswana: Millennium Development Goals Status Report. UNFPA, 2004. Accessed from on March 27, 2009.
  6. Author. Maternal mortality in 2005 : estimates developed by WHO, UNICEF, UNFPA, and the World Bank. World Health Organization, 2007. Accessed from on March 27, 2009.
  7. Joint United Nations Programme on HIV AIDS (UNAIDS). 2008 Report on the Global AIDS Epidemic, Geneva, Switzerland: UNAIDS, 2008. Accessed from
    on March 27, 2009.
  8. UNAIDS. “The HIV/AIDS Epidemic in Botswana.” 2004 Report on the Global AIDS Epidemic. UNAIDS, 2004.
  9. Author. “Botswana.” UNICEF, 2008. Accessed from on March 27, 2009.
  10. Weiser SD et al.  “A population-based study on alcohol and high-risk sexual behaviors in Botswana.” PLOS Medicine, 2006; 3 (10): e392. 
  11. Phorano O et al. “Alcohol abuse, gender-based violence and HIV/AIDS in Botswana: establishing the link based on empirical evidence.” Sahara J, 2005 Apr;2(1):188-202.
  12. Author. “Global Programs: Basha, Lesedi (Botswana).” FHI Focus on Youth. Family Health International. Accessed from on March 27, 2009.
  13. Author. Social Marketing for Adolescent Health. Population Reference Bureau, 2000.  Accessed from on March 27, 2009.
  14. Author.  “United Nations in Botswana.” UNFPA.  Accessed from on March 27, 2009.
  15. Devries, KO. “YouthLIFE – Botswana, Nigeria, and South Africa.” Advocates for Youth, 2003.  Accessed from on March 27, 2009.
  16. Author. Young People and HIV/AIDS: Opportunity in Crisis.  United Nations Children’s Fund, Joint United Nations Programme on HIV/AIDS, and World Health Organization, 2002.  Accessed from on May 4, 2009.
This publication is a part of the The Facts series.
Science & Success: Programs that Work to Prevent Subsequent Pregnancy among Adolescent Mothers Print

Also available in [PDF] format. Order publication online.

Table of Contents


Program Descriptions and Evaluation Results

  1. Queens Hospital Center’s Comprehensive Adolescent Program for Teenage Mothers and Their Children
  2. Health Care Program for First-Time Adolescent Mothers
  3. Nurse Home Visiting for First-Time Adolescent Mothers
  4. Polly T. McCabe Center for Pregnant Adolescents
  5. Women’s Centre of Jamaica Foundation Programme for Adolescent Mothers
  6. Home-Based Mentoring for First-Time Adolescent Mothers
  7. Intensive School-Based Program for Teen Mothers


© 2009, Advocates for Youth
Written by Sue Alford, MLS, with significant assistance from Anne Rutledge and Barbara Huberman.

This publication is part of Science and Success, Programs that Work series. 

Best Practices for Family Planning Clinics Print

This needs and assets assessment tool offers clinic administrators and staff an overview of “best practices” for family planning service delivery. Categorized into sections, the tool gives you an opportunity to learn about the latest research and best practices and then, using this information, rate how your clinic fares.  

The tool draws on research from four key sources:

  • Alford S. From Research to Practice: Youth-Friendly Reproductive and Sexual Health Services. Washington, DC: Advocates for Youth, 2009.
  • Alford S. Science and Success.  Washington, DC: Advocates for Youth, 2008.
  • Burlew R, Philliber S. What Helps in Providing Contraceptive Services for Teens. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2006.
  • Kirby D. Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases. Washington, DC: National Campaign, 2007.
It allows you to assess whether best practices are in place in your clinic with respect to: 
  • Confidentiality
  • Respectful treatment
  • Screening and counseling
  • Integrated services
  • Cultural competency
  • Accessible and affordable care
  • Reproductive and sexual health care
  • Staff development
  • Services for young men
  • Parent-child communication
Please indicate the degree to which you feel the organization practices each standard by circling the appropriate rating (1) to (5) where 1= never, 2= rarely, 3= sometimes, 4= often, and 5= always. Total your scores for each section to create an overall “category score.”


 I.  Confidentiality

Best Practice: Assure that Young People Have Confidential Access to Contraceptive Services.
1. Staff has a clear understanding of the state’s laws in relation to informed consent, client confidentiality, and parental notification.  1  2  3  4  5
2. Every clinic staff member, including receptionists, medical assistants, and technicians, is trained about the importance of guarding adolescents’ confidentiality.
 1  2  3  4  5
3. We emphasize the protections rather than limits of confidentiality when interacting with teens.  1  2  3  4  5
 4. We make sure always to have some counseling time alone with adolescent patients, even when they are accompanied to the appointment by a parent or a partner. Staff treats unaccompanied minors as well.
 1  2  3  4  5
5. We refer minors to a pharmacy where their confidentiality will be respected    
 1  2  3  4  5
6. We give extra assurances of confidentiality to HIV-positive youth, undocumented youth, older adolescents, GLBTQ youth, and pregnant and parenting teens.    
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  


 II.  Respectful Treatment

Best Practice: Treat Teens with Dignity and Respect.

1. Every staff member – from clinicians to receptionists – receives training in adolescent development and in treating youth respectfully. Staff is comfortable working with youth.
 1  2  3  4  5
2. Staff schedules longer visits with adolescent clients than with adults.
 1  2  3  4  5
3. All clinicians and counselors are trained in how to raise sensitive issues, including sexual health, condom and contraceptive use, substance use, interpersonal violence, and mental health.  1  2  3  4  5
4. Clinic staff treat every youth as a whole person and involves teens in their own health management.
 1  2  3  4  5
5. A clinic staff member always asks teen clients if they want a chaperone present during an examination.
 1  2  3  4  5
6. Clinicians explain the reasons for a particular test as well as what is involved in the test.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  


III.  Integrated Care

Best Practice: Use an Integrated, Multidisciplinary, Holistic Approach to Health Care.

1. We establish protocols to ensure that youth receive preventive counseling as recommended by GAPS (American Medical Association) or other major medical organizations.  1  2  3  4  5
2. We have protocols that ensure that clinicians screen and counsel every adolescent. We follow the recommendations of the American Medical Association, Society for Adolescent Medicine, and/or American Academy of Pediatrics.
 1  2  3  4  5
3. We screen every teen for depression, interpersonal violence, and a history of abuse because we know that these factors can have a profound effect on adolescents’ risk-taking and health-seeking behaviors.
 1  2  3  4  5
4. We screen every teen for current risk-taking behaviors, including substance use, unprotected sex, exposure to or participation in violent behaviors, poor nutrition, inadequate exercise, and social problems.
 1  2  3  4  5
5. We recognize that some teens, including teen parents and those in foster care, homeless shelters, juvenile detention centers, and substance abuse programs, have higher rates of risk-taking than other teens. Therefore, we set up strong referral systems, co-locate services, and/or establish collaborative partnerships with agencies who serve these youth.
 1  2  3  4  5
6. We develop links with school-based health clinics, which we know are especially effective in serving teens but are often unable to provide contraceptive and family planning services.
 1  2  3  4  5
7. Recognizing that many youth use the hospital emergency department as their usual source of care and, thus, may not receive comprehensive care, we connect with local ER’s so they can refer youth to us for family planning and other care.
 1  2  3  4  5
8. To the extent possible, we try to ensure continuity of care by making every effort to have teens see the same counselor and/or clinicians at every appointment.
 1  2  3  4  5
9. The breadth of the clinic’s services is widely advertised. Clinic staff actively use “in-reach” as well as outreach by asking adolescent clients to recommend services to their friends.
 1  2  3  4  5
10. We make referral appointments for adolescents and ensure that they know exactly where and when to go, giving them clear directions, assurances of continuing confidentiality and information about fees, if any.
 1  2  3  4  5
11. We provide a sheet of paper with the adolescent’s correctly spelled diagnosis and medications, if any, along with reliable, accurate consumer health information Web sites.
 1  2  3  4  5
12. We are aware that integrated care is especially important to some populations of youth, especially young men, pregnant teens, GLBTQ youth, HIV-positive adolescents, and sexual assault survivors.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  


 IV.  Cultural Competency

Best Practice: Offer Culturally Competent Services and Tailor Services to Meet the Needs of Teen Clients.

1. We have ongoing training for all staff regarding cultural norms, adolescent development, sexual orientation and gender identity, and cultural competency.
 1  2  3  4  5
2. We have clear, unambiguous policies against discrimination on the basis of sex, age, race/ethnicity, sexual orientation, religion, and gender identity. We ensure that the clinic or practice is a safe place for all clients and staff.
 1  2  3  4  5
3. We hire staff who represent our client population and who are diverse in many ways, including gender and ethnicity. We pay attention to gender role dynamics between staff and clients.
 1  2  3  4  5
4. We ensure that staff can communicate with clients in their own language(s). We ensure that bi-lingual staff is available, either during all operating hours or at set times and on set days.
 1  2  3  4  5
5. We ensure that age-appropriate, high quality consumer health materials and consent forms are available in all the languages that clients speak and for various reading levels, including low literacy.
 1  2  3  4  5

6. We involve young people in assessing the policies and services offered by the clinic and we take their recommendations seriously.
 1  2  3  4  5
7. Our waiting rooms and examining rooms have a gender neutral décor, reassuring both young men and young women that they belong there and are welcome.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  


 V.  Accessible and Affordable Services

Best Practice: Ensure that Services are Affordable and Accessible for Teens.

1. We offer transportation vouchers to youth and/or we link with community clinics in the area so that youth can use a clinic closer to their home,  school, or work.  1  2  3  4  5

2. We offer a special help-line that adolescents can use to inquire about services, to make appointments, and to request follow-up care.
 1  2  3  4  5
3. We offer flexible hours for adolescents including appointments in the evening and on weekends. We accept walk-in appointments.  1  2  3  4  5
4. We get a cell number and/or private e-mail address for youth. We contact youth within 24 hours with their test results and keep a confidential log book to document follow-up, treatment, and partner notifications
 1  2  3  4  5
5. We offer free or greatly reduced fees for services to teens.
 1  2  3  4  5
6. We dispense free or low cost prescriptions to teens.
 1  2  3  4  5
7. Where possible, we offer private billing accounts for teens to ensure confidentiality.
 1  2  3  4  5
8. We stock exam rooms (and /or the waiting room) with baskets of free condoms along with signs saying that youth are free to take as many as they feel they need.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  


 VI.  Reproductive & Sexual Health Services

Best Practice: Establish Teen-Specific Protocols for Reproductive & Sexual Health Services.

1. We use a teen-friendly standardized form for eliciting sexual history.
 1  2  3  4  5
2. We offer adolescent women a complete array of hormonal contraceptive methods. When an adolescent chooses the pill, patch, or ring, we encourage her to begin her method immediately and to use condoms for additional protection against pregnancy for the first seven days after she has begun.
 1  2  3  4  5
3. We explain the difference between the relative risks and the absolute risks associated with contraceptive options.
 1  2  3  4  5
4. We stress the importance of using dual protection – that is, of using hormonal contraception or other barrier method to prevent pregnancy and condoms to reduce the risk of HIV and STIs to all female clients, regardless of their sexual orientation. We counsel all sexually active youth to use condoms or dental dams at every act of sex to prevent or lessen the risk of infection with STIs, including HIV.
 1  2  3  4  5
5. We don’t require a pelvic exam before prescribing or dispensing hormonal contraception to adolescents. We do the first Pap test three years after the first experience of vaginal intercourse or at 21 years of age, whichever comes first.
 1  2  3  4  5
6. We don’t require a pregnancy test before offering emergency contraception. 
 1  2  3  4  5
7. For purposes of partner notification, we ask about sexual partners for the previous two weeks to one month for herpes and most bacterial infections, in the past two months for chlamydia and gonorrhea infections, and in the past year for HIV infection. We do not limit screening to symptomatic clients.
 1  2  3  4  5
8. We screen consistently for Chlamydia and Gonorrhea, using urine-based testing.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  


 VII.  Services for Young Men

Best Practice: Recognize that young men have sexual and reproductive health needs of their own.

1. We offer holistic care to all young men, regardless of their sexual orientation, that addresses their physical, emotional, and social health.
 1  2  3  4  5
2. We link with other community health clinics and agencies so that other agencies can refer young men to us and we can easily and readily refer young men to nearby care in venues where they will feel that no one will know why they are there.
 1  2  3  4  5
3. We train all clinic staff about the importance of guarding male adolescents’ confidentiality, especially with regard to their peers  1  2  3  4  5
4. We advertise the breadth of the clinic’s services, especially in venues where young men congregate. To make our services known, we use ‘in-reach’ as well as outreach, asking our clients to recommend our services to young men they know.
 1  2  3  4  5
5. We screen all young men under age 25 for Chlamydia and gonorrhea, except when the prevalence in our client population is less than two percent. We consider separately the populations of young men who do and do not have sex with other men. We do not limit screening to symptomatic males.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  


 VIII.  Parent-Child Communication

Best Practice:  Help parents support their teen’s reproductive and sexual health needs. 

1. We advertise and offer workshops for parents on how to talk with their teens and younger children about sensitive sexual health issues.
 1  2  3  4  5
2. We work with other agencies in our community to promote parenting skills and to prevent teen pregnancy, adolescent substance use, and other adolescent risk behaviors.
 1  2  3  4  5
3. We offer pamphlets, Web information, and other materials, in a variety of languages and reading levels to help parents talk with adolescents about sexuality and other sensitive health issues.  1  2  3  4  5
4. We help parents understand the importance of confidential care for adolescents.
 1  2  3  4  5
My overall score for this category is (add up all the numbers):  

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